Greater omentum free flap

A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity...

INTRODUCTION: Microdialysis allows postoperative monitoring of free flaps. It allows determining their cellular metabolism in vivo by measuring glucose, lactate, and pyruvate. We report an application on a greater omentum free flap. CASE REPORT: A 77 year old female patient was operated for a vertex angiosarcoma. A large loss of vertex substance (175cm(2)) was rebuilt with a greater omentum free flap. Monitoring included hourly clinical observation (color, temperature, aspect), and flap surveillance using microdialysis CMA 60((R)) catheter...

INTRODUCTION: Locoregional breast cancer recurrence can be detected at an advanced stage of the disease. To achieve local control for these larger local breast cancer recurrences, wide soft tissue resections with autologous tissue coverage of the defect is an option. The aim of this study was to assess the local control and morbidity of surgical salvage of patients with advanced local breast cancer recurrence using autologous tissue closure of the defect. MATERIAL AND METHODS: Eighty-eight patients were treated with wide soft tissue resections with autologous tissue coverage from 1993 to 2006...

We review our experience in the treatment of complex large chest-wall defects needing a multidisciplinary approach due to primary or secondary neoplasms. Non-small cell lung cancer with chest-wall invasion cases are excluded. Fifteen patients underwent whole thickness resection of the chest wall due to lesions affecting at least three ribs, sternum, clavicle or thoracic spine and the surrounding soft tissue. Previously operated breast cancer and sarcoma were the most frequent diagnoses. Partial or total sternectomy plus rib resection was performed in 8 patients...

Microvascular transfer of the omentum provides well-vascularized and pliable tissue but has not widely been used in vascular extremity reconstruction because of the potentially high donor site morbidity caused by the necessary laparotomy. Laparoscopic minimally invasive harvest of a free greater omentum flap and microsurgical transfer of this tissue with split skin grafts on top and connected to sequential vein bypasses may be a an interesting new modality when other reconstructive options are absent or scarce...

OBJECTIVE: To evaluate the clinical efficacy of greater omentum in reconstruction of refractory wounds. METHODS: From August 1988 to May 2001, 20 patients with refractory wound underwent pedicle or microvascular free transfer of the greater omentum. Indications of surgery were electrical injury of the wrist and hand in 9 patients, electrical injury of the scalp and cranial bones in 3, avulsion injury of the scalp in 2, radiation-related ulcer of the chest wall in 2, ulcer and osteomyelitis following resection of the sternum sarcoma in 1, electrical injury of the abdomen in 1, bone and soft tissue defects following compound fracture of the leg in 1, and extensive scar and ulcer of the leg and footdrop following trauma in 1...

OBJECTIVE: To reduce amputation rate of most severe pattern (Type III) of electrical burns of wrist. METHODS: Early wrist decompression followed by selective transfusion of dextran, PGE1, low molecule heparin to prevent thrombosis of injured radial and ulnar arteries, vascular bridging across the distal forearm and wrist to the hand soon after the appearance of circulatory failure to the hand. Free tissue transfer, especially the use of greater omentum and the innovated abdominal flaps, to repair the circumferential wounds of the wrists are recommended...

BACKGROUND: Malignant lesions of the pharyngoesophagus often require total laryngopharyngectomy and mediastinal dissection. As a result of the current treatment paradigms for advanced laryngopharyngeal cancers, it is common that the surgical field has been previously irradiated or exposed to systemic chemotherapy, resulting in fistula rates as high as 78% and mortality as high as 8%. The free vascularized tubed gastric antrum and the accompanying greater omentum offer a single-staged method of pharyngoesophageal reconstruction, with the added benefit of protection of the great vessels, the tracheal stump, and the mediastinal contents in a high-risk surgical field...

Taking into account the angiogenic properties of the omentum to revascularize ischemic tissues, this experimental, longitudinal, prospective, double-blind study in rabbits was designed to revascularize and preserve the mobility of a digital osteotendinous structure surgically devascularized in advance and to compare such omental angiogenic ability with that of the muscle and the panniculus carnosus. Thirty New Zealand rabbits were used. Three toes from the hind feet were surgically amputated from each rabbit...

Anatomo--morphological peculiarities of greater omentum (GO) in 63 patients, in whom its flap was applied for revascularization of ischemized tissues of extremities, myocardium and the brain, were studied up. Microsurgical transplantation of the GO free flap was performed in 41 patient, omentocardiopexy without the break of the GO vascular pedicle--in 22. Possibilities of the GO application for the ischemized organs revascularization were estimated.

The paper presents method of restoration of protective sensation after major hand injuries primarily treated with great omental flap. Existing methods have been modified on assumption that free end of transplanted sural nerve might act as sensation receptor. Two patients were operated on. Several months after surgery patients reported paresthesiae at skin compression. Function improvement is seemingly indicated by objects less frequently falling of out of the hand.

Transsternal approach is commonly used in majority of operations in heart surgery. In 0.5-5.9% of patients after median sternotomy osteomyelitis of the sternum and the ribs develops. The authors set forth their experience in surgical treatment of 182 such patients. In 97% of them total resection of the sternum was combined with simultaneous resection of costal cartilages which were involved in pyogenous inflammatory process. Costal cartilages were resected during subtotal resection of the sternum in 95% of cases and ribs--in 25%...

Patients suffering from long-untreated malignomas of the chest or abdominal wall may require plastic surgery due to extensive defects after tumor resection. Despite a variety of pedicled or free myocutaneous flaps, there are defects in which these reconstructional options may not be indicated. In these patients, the omental flaps are a valid alternative. Since a secondary split skin graft is mandatory with the omentum flap, antibacterial and granulation-enhancing xerodressings are required for wound bed conditioning...

Technological progress in reconstructive surgery, in particular the use of pedunculated or free flaps, has given new impetus to head and neck dissection. This stems from the fact that such techniques provide greater oncological radicality, reduce the number of severe post-operative complications and give better quality of life. The present study examines 154 patients suffering from upper aero-digestive tract neoplasms (131 males and 23 females; age range 23-82 years) who had undergone radical surgery. Reconstruction was performed with flaps in 154 cases: 119 pedunculated flaps (102 large myocutaneous pectoral and 17 temporal muscle flaps) and 35 free flaps (18 radial osteofasciocutaneous, 13 radial fasciocutaneous and 4 omentum flaps)...

A series of 13 patients (12 males, 1 female, aged 5-57) operated between 1990 and 1997 is presented. In 12 cases the greater omentum was used to cover tissue defect within upper extremity, in 1 case--lower extremity. Complications at donor site and within extremity were assessed in two groups (group I--5 cases of free omentum graft, group II--8 cases of pedicled omentum graft). Two acceptor site complications (flap necrosis and osteomyelitis) and no donor site complications were observed in group I. In group II 2 similar donor site complications occurred but 5 patients from this group complained of strong abdominal pain due to excessively short pedicle of the graft and 1 case of abdominal hernia occurred...

Simultaneous resurfacing of extensive soft-tissue defects involving both lower extremities can be performed successfully with free hemiflaps harvested from the omentum. This avoids the need for staged operations or for separate donor sites with the concomitant morbidities, the possible need for intraoperative repositioning, and the significantly greater operative time. During the past 3 years, six omental free hemiflaps were performed in three patients for bilateral lower limb reconstruction. All patients had extensive ulcerations, averaging 207...

BACKGROUND: Reconstruction of the complex pharyngeal wound after radiotherapy presents a surgical challenge. METHODS: Evaluation of the gastro-omental flap in the reconstruction of the pharynx and overlying soft tissue after local flap failure. RESULTS: A 70-year-old patient underwent a total laryngectomy and radical neck dissection after 70 Gy of external beam radiotherapy for an advanced squamous cell carcinoma of the pyriform sinus. Postoperatively, a large pharyngocutaneous fistula developed...

We have studied 66 patients who underwent esophageal reconstruction using microvascular anastomoses. This series comprises 28 patients with reconstruction using a free jejunal interposition between the pharynx and the cervical esophagus following pharyngolaryngoesophagectomy for hypopharyngeal carcinoma and 38 atypical patients in whom other methods of reconstruction were used. Successful transfer was achieved in 98.5 percent (65 of 66). Issues concerning atypical reconstruction and our procedures in these cases are discussed...

Dissection of the rat omentum were performed to study the feasibility of rat omental free transfer. The right epiploic vessels were found to be adequate for anastomosis in transfer. Twelve omental free flaps were transferred to the groin, with 100% survival of flaps in the 10 animals that survived the operation. The artery and vein averaged 0.3 and 0.4 mm in diameter, respectively. The average pedicle length was 5 mm, and the average flap weight was 136.9 mg. This omental transplant offers a new experimental means of studying lymphedema, neovascularization, and tissue revascularization...

BACKGROUND: The reconstruction of extensive neck defects with minimum deformity and rapid return to normal food intake is successfully achieved by the use of gastro-omental flaps. We report a series of 18 patients who underwent such reconstructive surgery for major full-thickness defects involving the skin in addition to the larynx and pharynx. Fifteen patients had earlier undergone radiotherapy and 3 chemoradiotherapy; 14 of them had undergone previous surgery. The cause of the defect was tumor recurrence in 10 patients, a pharyngostoma in 6, and postoperative cellulitis in 2...